scholarly journals Diverse activation patterns during persistent atrial fibrillation by noncontact charge‐density mapping of human atrium

2020 ◽  
Vol 36 (4) ◽  
pp. 692-702 ◽  
Author(s):  
Rui Shi ◽  
Zhong Chen ◽  
Charlie Butcher ◽  
Junaid AB Zaman ◽  
Vennela Boyalla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Charge Density ◽  
Persistent Atrial Fibrillation ◽  
Human Atrium ◽  
Activation Patterns ◽  
Density Mapping

Application of recurrence plot analysis to characterise whole chamber propagation of atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Pope ◽  
P Kuklik ◽  
A Briosa E Gala ◽  
M Leo ◽  
J Paisey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Charge Density ◽  
De Novo ◽  
Inverse Correlation ◽  
Right Atrial ◽  
Research Centre ◽  
Activation Patterns ◽  
Density Mapping ◽  
Distance Matrices

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Oxford Biomedical Research Centre Introduction Non-contact charge density mapping allows visualisation of whole chamber propagation during atrial fibrillation (AF). The identification of regions with repetitive or, conversely, more complex patterns of wavefront propagation may provide clues to mechanisms responsible for AF maintenance and lead to improved outcomes from catheter ablation. Our novel mapping approach based on signal recurrence plots has never been applied to whole chamber, bi-atrial recording of atrial fibrillation. Purpose To apply recurrence analysis to characterise whole chamber bi-atrial AF propagation. Methods Non-contact dipole signals from left and right atrial maps were obtained during simultaneous bi-atrial charge density mapping of AF. Signals were converted to phase and mean phase coherence calculated for the generation of recurrence distance matrices for the whole chamber and each anatomical region (6x LA and 4x RA) over the 30-second recording duration, where a value of 1 (purple, see figure panel A) represents uniform repetitive conduction, and 0 (red), irregular, non-repetitive activity. Whole chamber and regional mean recurrence values were calculated and correlated with the frequency of wavefronts of localised irregular activation patterns. Results Maps were obtained prior to ablation in 21 patients (5 paroxysmal (pAF), 16 persistent AF (persAF)) undergoing de-novo catheter ablation procedures. Whole chamber recurrence was higher in patients with pAF (0.40 ± 0.08) than persAF (0.34 ± 0.05), p < 0.0005. There was an inverse correlation between regional recurrence values and the number of localised irregular activations detected (-0.7021, p < 0.0005, figure panel B) with the lateral LA and anterior RA demonstrating the highest recurrence values in each chamber (figure panel C). Conclusion Use of recurrence distance matrices characterises global AF propagation phenotypes. Regional values are inversely correlated with the frequency of localised irregular activation patterns identified demonstrating an anatomic dependence in the level of AF propagation complexity, greatest in the anterior LA and septal RA. Comparison of strategies targeting regions with maximal vs. minimal values during catheter ablation may define an optimal approach to treatment of persistent AF. Abstract Figure. Recurrence abstract figure

P3756Diverse activation patterns during persistent atrial fibrillation characterised by dipole density non-contact mapping

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Shi ◽  
Z Chen ◽  
C Butcher ◽  
Z Zaman ◽  
V Boyalla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Simultaneous Recording ◽  
Activation Patterns ◽  
Contact Mapping ◽  
Density Mapping ◽  
Slow Conduction ◽  
Underlying Mechanisms ◽  
Dipole Density ◽  
Endocardial Activation

Abstract Background Global simultaneous recording of activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for a personalised ablation strategy to treat persistent AF. Purpose To characterise left atrial endocardial activation patterns during AF using a novel non-contact dipole density mapping. Methods Activation patterns were characterised into three sub-types: (i) focal with centrifugal activation (FCA); (ii) localised rotational activation (LRA); (iii) localised irregular activation (LIA). Continuous activation patterns were quantified and distributed in the left atrium. Results A total of 144 persistent AF segments with 1068 activation patterns from 25 patients were analysed. The most common pattern was LIA (63%), which consist of four disparate features: slow conduction (45%), pivoting (30%), collision (16%) and acceleration (7%). LRA was the second commonest pattern (20%). FCA (17%) arose frequently from the PVs/ostia. Continuous AF activations comprise multiple combinations of FCA, LRA and LIA, transitioning from one to the next without a discernible order. Preferential conduction areas were typically seen in mid-anterior (48%) and lower-posterior (40%) walls where dominant activations were made up of LRA and LIA. Conclusion AF is characterised by heterogenous activation patterns that vary between individuals. Clinical implications of individualised ablation strategies guided by dipole density mapping will have to be determined. Acknowledgement/Funding None

scholarly journals Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Ramanathan Parameswaran ◽  
Jonathan M. Kalman ◽  
Alistair Royse ◽  
John Goldblatt ◽  
Marco Larobina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Temporal Heterogeneity ◽  
Activation Patterns ◽  
3 Dimensional ◽  
Transmural Migration ◽  
Endocardial Mapping ◽  
Phase Mapping ◽  
Insight Into ◽  
Activation Mapping

Background: Endocardial-epicardial dissociation and focal breakthroughs in humans with atrial fibrillation (AF) have been recently demonstrated using activation mapping of short 10-second AF segments. In the current study, we used simultaneous endo-epi phase mapping to characterize endo-epi activation patterns on long segments of human persistent AF. Methods: Simultaneous intraoperative mapping of endo- and epicardial lateral right atrium wall was performed in patients with persistent AF using 2 high-density grid catheters (16 electrodes, 3 mm spacing). Filtered unipolar and bipolar electrograms of continuous 2-minute AF recordings and electrodes locations were exported for phase analyses. We defined endocardial-epicardial dissociation as phase difference of ≥20 ms between paired endo-epi electrodes. Wavefronts were classified as rotations, single wavefronts, focal waves, or disorganized activity as per standard criteria. Endo-Epi wavefront patterns were simultaneously compared on dynamic phase maps. Complex fractionated electrograms were defined as bipolar electrograms with ≥5 directional changes occupying at least 70% of sample duration. Results: Fourteen patients with persistent AF undergoing cardiac surgery were included. Endocardial-epicardial dissociation was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganized activity (Endo: 41.3% versus Epi: 46.8%, P =0.0194) and single wavefronts (Endo: 31.3% versus Epi: 28.1%, P =0.129) were the dominant patterns. Transient rotations (Endo: 22% versus Epi: 19.2%, P =0.169; mean duration: 590±140 ms) and nonsustained focal waves (Endo: 1.2% versus Epi: 1.6%, P =0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. Electrogram fractionation was significantly higher in the epicardium than endocardium (61.2% versus 51.6%, P <0.0001). Conclusions: Simultaneous endo-epi phase mapping of prolonged human persistent AF recordings shows significant Endocardial-epicardial dissociation marked temporal heterogeneity, discordant and transitioning wavefronts patterns and complex fractionations. No sustained focal activity was observed. Such complex 3-dimensional interactions provide insight into why endocardial mapping alone may not fully characterize the AF mechanism and why endocardial ablation may not be sufficient. Graphic Abstract: A graphic abstract is available for this article.

Identification of repetitive atrial activation patterns in persistent atrial fibrillation by direct contact high‐density electrogram mapping

2019 ◽  
Vol 30 (12) ◽  
pp. 2704-2712 ◽  
Author(s):  
Michael Wolf ◽  
René Tavernier ◽  
Ziad Zeidan ◽  
Milad El Haddad ◽  
Yves Vandekerckhove ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Direct Contact ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Activation Patterns ◽  
Atrial Activation
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